Provider Demographics
NPI:1720013691
Name:SAGE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SAGE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-253-4670
Mailing Address - Street 1:2 S. THIRD ST.
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:99134-0072
Mailing Address - Country:US
Mailing Address - Phone:509-253-4670
Mailing Address - Fax:509-253-4675
Practice Address - Street 1:2 S. THIRD ST.
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:99134-0072
Practice Address - Country:US
Practice Address - Phone:509-253-4670
Practice Address - Fax:509-253-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9057845Medicaid
WA9057845Medicaid